Background

Serious traumatic injury is a leading cause of death and disability globally, with the majority of survivors developing chronic pain.

We present the first systematic review conducted by the UK Defence Medical Services in conjunction with the Cochrane Collaboration. Irrigation fluids are used to remove contamination during the surgical treatment of traumatic wounds in order to prevent infection. This review aims to determine whether there is evidence that one wound irrigation fluid is superior to another at reducing infection. A pre-published methodology was used and two reviewers independently assessed the search results. The search produced 917 studies, of which three met the inclusion criteria. All were studies in open fractures, incorporating a total of 2,903 patients. Each RCT involved a distinct comparison, precluding meta-analysis: i) sterile saline vs. distilled/boiled water; ii) antibiotic solution vs. soap solution; iii) saline vs. soap solution. The odds ratios of infection following irrigation with various fluids was as follows: i) saline vs. distilled or boiled water 0.25 (95%CI 0.08–0.73); ii) antibiotic solution vs. soap 1.42 (95%CI 0.82–2.46); iii) saline vs. soap solution 1.00 (95%CI 0.80–1.26). These results suggest that neither soap nor antibiotic solution is superior to saline and that saline is inferior to distilled or boiled water.

The TRISS methodology is used in by both the UK and US military trauma registries and relies on dividing casualties according to mechanism: penetrating or blunt. The UK and US military trauma registries use the original coefficients devised in 1987 and it is not clear how either registry analyses explosive casualties according to the TRISS methodology. This study aims to use the UK military trauma registry (JTTR) to calculate new TRISS coefficients for contemporary battlefield casualties injured by either gunshot or explosive mechanisms. The JTTR was searched for all UK Casualties injured or killed between 2003 and 2014. A logistic regression analysis was performed to devise new TRISS coefficients, these were then used to re-examine survival over the 12 years of the study. Comparing the predictions from the GSW TRISS model to the observed outcomes, it demonstrates a sensitivity of 98.1% and a specificity of 96.8% and an overall accuracy 97.8%. With respect to the explosive TRISS model, there is a sensitivity of 98.6%, a specificity of 97.4% and an overall accuracy of 98.4%. When this improved TRISS methodology was used to measure changes in survival, there was a sustained improvement over the 12-year study period.

The aim of this study was to characterise injury patterns and examine whether survival had improved over the last decade of conflict in Iraq and Afghanistan. A logistical regression model was applied to all UK casualty data from the Joint Theatre Trauma Registry.

There were 2785 casualties over the 10-years. 72% of casualties from hostile action were injured by blast weapons. The extremities were the post commonly injured body region, being involved in 43% of all injuries sustained. The New Injury Severity Score that was observed to be associated with a 50% chance of survival rose every year from 38 in 2003 to 62 in 2012. The odds ratio of surviving with a Trauma and Injury Severity Score (TRISS) of 50% rose by 1.349 (95% CI = 1.265–1.442) per year. The actual TRISS value associated with a 50% chance of survival dropped every year from 35.3% in 2003 to 0.9 in 2010 and was un-calculable in 2011–12.

This study confirms that the last decade of conflict has been characterised by blast wounds and injuries involving the extremities. A consistent improvement in survival over the 10 years has been demonstrated, to the point that traditional metrics for measuring improvement in trauma care have been exhausted.